I hear the deeply emotional personal stories from clients all the time about seeking medical care and being told, no matter the issue, to just lose weight. I often sit and listen to clients and their experiences with mouth agape and head shaking in disbelief. One client just recently told me about hurting her knee years ago, going to the doctor, being told to lose weight, and receiving no further treatment such as an MRI to rule out a tear or serious issue. Turns out she did have a tear that with treatment and/or surgery might have been resolved, but instead, now years later, she is still dealing with pain and mobility issues as a result.
This is just one of many experiences like this that I hear about weekly in my conversations with clients, family, and friends. These aren’t just stories, the research also supports that, while sometimes unintentional, weight bias and anti-fat attitudes are pervasive and very much ingrained, not just among medical providers, but throughout our culture.
What is Weight Stigma?
If you aren’t familiar with the term, weight stigma is defined as, “discrimination, social disapproval, or stereotyping based on a person’s weight or body size.” Weight stigma is a direct outcome of weight bias, which is the negative assumptions, opinions, and stereotypes associated with weight. Weight stigma and bias are widespread, existing in our schools, workplaces, in the media, and in healthcare and research.
Although, it is still a major work in progress, there is rising awareness that weight stigma and the biases we hold around people in larger bodies are a serious problem and that the impacts are wide reaching. The negative assumptions we make based on weight impact both the mental and physical well-being and health mostly of people in larger bodies, but also impact people in bodies of all shapes and sizes.
The Impact of Weight Stigma
A systematic review of 33 studies on weight stigma and the psychological and physiological health outcomes in adults found that weight stigma was associated with:
- Increased diabetes risk
- Higher cortisol level (the stress hormone) & C-reactive protein level (a measure of inflammation)
- Increased oxidative stress level
- Unhealthy weight control practices
- Avoidance of physical activity
- Higher levels of depression & anxiety
- Negative self-esteem and body dissatisfaction
- Increased risk for eating disorders
Ironically, weight stigma and anti-fat bias inhibits and undermines the very thing we claim to be trying to help people change, leading to weight gain and poorer physical and psychological health. Sadly, despite the negative impact, it remains socially acceptable to shame, judge, and stigmatize people based on their weight and size and shape of their body. And, unfortunately, the belief that thin is desirable starts at an incredibly early age, with data showing weight bias in kids as young as six.
When we recommend weight loss, make negative comments about people’s bodies, concern troll by expressing concern about people’s health in larger bodies, or provide healthcare that is any different than what we provide a person in a smaller body we are actually harming their health, not helping. When we blame and shame and use the language we typically use to pathologize people in larger bodies, such as obese and morbidly obese, we end up alienating and undermining discussions around health and health behaviors.
What We Can Do Instead
Anti-fat bias and internalizing that bias isn’t necessarily something you decide to do, it is just a consequence of living in a world that has declared war on obesity and therefore on people living in larger bodies.
We all have biases; some we are conscious of (explicit biases) and others exist more unconsciously (implicit biases). In an article titled, Bias Is Universal. Awareness Can Assure Justice, in the New York Times, Neill Franklin made this insightful comment, “The key isn’t to feel guilty about our biases, guilt tends toward inaction. It is to become consciously aware of them, minimize them to the greatest extent possible, and constantly check in with ourselves to ensure we are acting based on a rational assessment of the situation rather than on stereotypes and prejudices.” Although his comment was regarding racial biases, this same ideology can be applied to the biases we hold around people in larger bodies.
The answer is not to just continue to judge, stigmatize, and make assumptions about people, their behaviors and their weight or insist for all people in larger bodies to simply become smaller (ask any person living in a larger body and see how simple that is). Shame and judgement of ourselves or others is not the answer. So what is?
An Alternative, More Compassionate Approach
An alternative approach if a doctor or other health professional or friend or loved one is concerned about someone’s health would be to ask them first for their consent in the conversation. If they are open to the conversation, you might then ask meaningful questions about their self-care and behaviors around eating and food, movement, sleep, stress, and their emotional and psychological health. The science of weight and health are not as simple as calories in/calories out.
Our collective goal should be to treat all people with compassion, basic human decency, and respect and focus on behaviors, not weight. I may sound like a broken record at this point for those of you who read my blogs regularly, but if your goal is health, or as a health professional, your goal is to help people be not only physically healthier, but also mentally and emotionally, a focus on behaviors versus weight is far more beneficial. All people in all bodies deserve care, compassion, and respect.
As medical professionals, one way to think about it is to consider what it might look like to give the same treatment to people in larger bodies that we would to people in smaller bodies. The best way to provide ethically sound healthcare is for medical professionals, doctors, nurses, dietitians, therapists, etc. to avoid making assumptions and basing their treatment/recommendations on weight or body size and shape.
For instance, if a patient comes in with a complaint of knee pain instead of just telling someone in a larger body to lose weight, give that person the very same treatment you would someone in a smaller, thin body, whether that is anti-inflammatories, further tests like an MRI to rule out serious issues or possibly physical therapy. Far too often patients, no matter their complaint or problem are given a diet or told that they must lose weight before they can be treated. Using the knee problem again as an example, what happens is that the patient goes untreated, the problem worsens, and then when patients muster up the guts to come back in for help the worsening of the problem is seen as a weight issue instead of being a lack of treatment early enough issue.
“Eat Less, Move More” Advice Isn’t Helpful
The advice of lose weight and eat less/move more isn’t helpful for most people. Despite what we are sold by the diet and wellness industry, when we look at the evidence, there is no scientifically proven way for the majority of people to lose weight and keep it off long term. When you look at the data of any intentional weight loss intervention at the 2-5 year mark the failure rate is dismal (not of the people doing them, but of the diets/interventions themselves.) So, is it really ethical to promote weight loss as a solution? Or would it be more ethically sound to focus on behaviors and habits people can actually do to take care of themselves?
In my weight-inclusive practice and through the framework of intuitive and mindful eating I focus on helping people work towards their goals around health and wellness without a focus on the scale. Taking the focus off weight is ultimately far more health promoting, sustainable, and life-enriching. People are so much more than just bodies and the number on the scale or BMI. We are individuals, not statistics or categorizations based on an archaic measure. While the intentions behind prescribing diets, conversations focused on weight loss, and the discussion of weight and health may be good, hopefully after reading this we all can agree, the impact clearly is not.
How to Learn More
Ask yourself if you hold negative opinions about people with excess weight. If so, remember weight is complex with multiple contributing factors including genetic, biological, and other noncontrollable factors. If you are interested in learning more about shifting our perspective to focusing on behaviors instead of weight, I highly recommend googling the article, “Weight Science: Evaluating the Evidence for a Paradigm Shift,” an evidence-based paper on the subject. If you aren’t sure about your own implicit biases, those biases we have that are outside of our consciousness and control and would like to better recognize those biases a helpful tool to check out is Harvard’s Implicit Bias Test, a tool intended to raise awareness in various areas where it is common to hold biases. Locate that at implicit.harvard.edu, click on Take a Test and look for the Weight IAT. If you would like to learn more about these concepts in general, please visit asdah.org.
If you are a doctor, medical professional or business and are interested in you and your staff raising awareness about weight stigma and bias and how we can help without causing further harm, please contact me. I am available to present to you and your office, either virtually or in person.